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CEP BPSD Discussion Guide ENG RFCG Updated2019 PDF
CEP BPSD Discussion Guide ENG RFCG Updated2019 PDF
Antipsychotic medications are used to treat a variety of different mental health conditions. They may be used to treat people
with dementia when an individual has certain responsive behaviours and not responding to non-medication approaches
to care. In most cases, antipsychotic medications should not be the first choice for treatment of responsive behaviours but
instead the care team should focus on creating a supportive environment, and investigating and satisfying the unmet needs
of the person with dementia. As a member of the care team, you have an important role to play in helping the health care
providers decide whether this treatment is appropriate care for your family member or friend. This guide will help you learn
more about how antipsychotic medications are used to help people with dementia.
Dementia is the general name for a set of symptoms that are caused by physical changes that
affect the brain. The most common kind of dementia is Alzheimer’s disease, but there are several
other kinds, such as Lewy Body dementia, frontotemporal dementia, and vascular dementia. People
with dementia have trouble with memory, thinking, problem-solving and communicating. These
problems make it hard for them to do day-to-day activities.
A person with dementia might also experience changes in their mood or behaviour, such as:
• Seeing or believing things that are not real
• Being confused and scared
• Feeling agitated, depressed, or irritable
• Lacking interest in activities
These experiences can be a common part of the way the disease develops. They are often a response to
the way the person with dementia feels, or they may be a reaction to a change in their environment.
Some of these responsive behaviours can be upsetting for the person with dementia and for others.
Health care providers are trained to manage these behaviours. As a close friend or family member
you can help the care team to better understand what might be causing these behaviours.
What Are the Behavioural and Psychological Symptoms of Dementia? (i.e. responsive behaviours)
For now, there is no cure for dementia and no way to stop it from getting worse over time. Some
medications may help manage symptoms like hallucinations, delusions, severe agitation and
severe physical reactions when they are very upsetting or dangerous to the individual with
dementia or to others. Other medications help with depression or anxiety.
Even if a doctor or nurse practitioner prescribes medications, many non-medication approaches to
care can help manage responsive behaviours caused by dementia. The care team will involve the
person with dementia and their family or friends to find the approaches they think will work best.
As a first step, the care team will look for ways to manage the responsive behaviours without using
medication. The most effective ways focus on creating a supportive environment, and investigating
and satisfying the unmet needs of the person with dementia. The care team will try to:
• Understand all they can about the person
• Understand what makes the person feel calm and safe
• Understand what may be causing the responsive behaviours
• Set up a safe and comfortable environment, and routines that match the person’s habits and
preferences
• Remove loud and distracting things or events
• Treat the person with respect and compassion
• Communicate with simple words and phrases
• Offer therapies and recreational activities that are meaningful and enjoyable
• Understand how responsive behaviours can change at different times of the day
• Remember that some responsive behaviours are a regular reaction to things like frustration
or sadness, and may not be a symptom related to their dementia
• Identify the cause of the resistance, change the routine and ways of doing things
• Reassure, address the possible cause, distract*
Repetitive questions/
• Put the answer to the same repetitive question on a piece of paper or card and
mannerisms ask the person to read the card instead
• Ensure the person’s environment remains safe
Collecting
• Be compassionate
Disinhibition • Distract*, re-direct them to more appropriate behaviour or a more appropriate
(e.g., disrobing, masturbation in public, location for the behaviour
hyper sexuality)
* When distracting, make sure the activity has a meaning or purpose (based on the person’s preferences and
history) and ask questions like “I need your help to....” or “do you think you can help me with this”.
Side Effects
Some of the more common side effects are:
• Feeling sleepy or groggy
• Confusion
• Weight gain
• High blood sugar
• High cholesterol
• Dizziness caused by low blood pressure
: Likely to be helped by antipsychotics
• Constipation
• Swelling, usually around the ankles : Likely to have no benefit from using
antipsychotics
• Problems urinating (more common in older men)
: Likely to have a stroke or die*
• Tight muscles that make the person shuffle or take short steps
*There is research to show that for every 100
Some of the less common side effects are: people with dementia who take antipsy-
chotics one person is likely to have a stroke
• Shaking in the hands or arms or die (mostly related to heart failure, sud-
• Restlessness or needing to walk around a lot den death, pneumonia). However, it is hard
• Twitching face to tell if the antipsychotic medicine was the
cause, because those with dementia are
• Stroke often at high risk even when not taking an
• Death antipsychotic.
References
Additional references can be found in Centre for Effective Practice (CEP)’s Discussion Guide for providers at https://
cep.health/dementia. This resource for residents, families, and caregivers was developed from feedback given
by our long-term care stakeholder organizations, providers, and residents, who identified a need for a resource
that supports consistent language and approaches for antipsychotic use for dementia across the care team. This
resource was adapted, with permission, from work at the University of Iowa and Health Literacy Iowa, and CEP’s
Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia Discussion Guide.
CEP is grateful to the providers, residents, family members, and caregivers that provided feedback throughout the
development process of this resource.
[1] Alzheimer Society Canada. What is dementia? (accessed February 2016). https://link.cep.health/
bpsd32
[2] Alzheimer Society Ontario. Shifting focus: a guide to understanding dementia behaviour. 2013
(accessed February 2016). https://link.cep.health/bpsd33
Adapted from:
University of Iowa and Health Literacy Iowa. (2013). Antipsychotic Medicines for People with
Dementia. For more information please see: https://link.cep.health/bpsd34
Centre for Effective Practice. (2016). Use of Antipsychotics in Behavioural and Psychological
Symptoms of Dementia (BPSD) Discussion Guide: Long-Term Care (LTC Edition). For more information
please see: https://cep.health/dementia
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